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Operational Transformation of St. Rose Hospital Edwin HernandezTravis YoungNatalie EloskofChintan SomaiyaThe DebtSTRATEGY OVERVIEWImprove operations Physician integration and creating a favorable payer mixCommunity outreachStrategic Planning ProcessExecute Plan & Assess the Success Rate Implement Strategies & Set Measurable Goals Identify Objectives, Major Initiatives & Key Success Areas SWOT Analysis and Core Competencies Identify Effects of External EnvironmentChanging Payer MixFinancial Impact on HospitalsPayment AreaPayment Reduction Over 10 years (Billions)Payment Reductions: New Payments for Care$177.3 Market Basket Update$ -112.6 Disproportionate Share Cuts$ -36.1 Reduced Readmissions$ -7.1 Hospital Acquired Conditions$ -1.5 Accountable Care Organization$ -1.5Net Aggregate Financial Impact on U.S. Hospitals$17.06Insurance ProfileAreaPopulation UninsuredAll ages0-17 years18-64 yearsAlameda County171,43012%6%15%Hayward22,28916%7%21%Eligible People in Service AreaPopulationPercentage74,981390,61519.2%* Approximately 30% of inpatients receive services out of the areaAlameda Alliance for Health: Market Share by Hospital 20102011St. Rose Hospital14.4%16.4%Primary Goal Increase the volume of Insured PatientsFinancial Profile20102011Operating Revenue$147,013,000$160,444,000Operating Expense$130,801,560$150,681,628Operating Margin-0.27%-14.57%Days in A/R65.144.7Charity Care Charges in ED$5,044,888$5,091,996* Large change found in unaudited and audited numbersRevenue Cycle ImperativesChanges with Accountable Care ActExpanded CoveragePayment CutsNew RequirementsEconomic IncentivesImproving Performance and EfficiencyEligibility ProcessDenials Prevention

Charity Care PoliciesPhysician IntegrationKey Operation InitiativesNurse Navigator in the ED informs patients of financial resources Provide automated pre-admission insurance verification, counseling, and price estimates at registrationDistinguish between charity care and bad debt accounts Renegotiate contract with Alameda Alliance HealthRe-license suspended beds for pediatric services ( 7- beds) and medical surgical services (10 - beds)

Pediatric ServicesWe cannot give Washington Hospital Fremont the sole responsibility for caring for pediatric patients. SRH service area population age distribution 2016 ProjectionPopulation% of Total Age 0 - 1485,79820.4%Based on WHFs charge master price for Pediatric room and careRevenue from 7 Pediatric Beds$2,063,418Operational BenefitsProjected from Comparable Hospitals resultsOverall Increase cash as a % of net revenueReduce Bad Debt Charges by 48.6%~$5 millionReclassify Bad Debt to Charity Care by 15.5%~$7 millionDecrease in Overall Uncompensated Care by 16.6%~$2 millionAdditional Revenue from Pediatric Beds~$500,000Total~$14.5 million* Source Healthcare Financial Management AssociationNext StepsImproving Physician IntegrationCreate a sense of urgencySelect physician champions to become advocates for the hospital to increase referralsCreate and train a physician leadership team

Improving the continuum of careACA will not pay for readmissionBe proactive Create bonuses off decreasing readmission ratesTelemedicine and discharge planningDecreasing readmission rates

Readmission ratesPhysician Leadership Team GoalsCreating A Favorable Payer Mix% of Payer MixPLANDetermine service lines that attract third-party patientsCan we Increase utilization?Analyze cardiology and obstetric departments system issuesCan we increase utilization? Is patient scheduling an efficient process?

Study the demographicsHispanic -33%, Asian-29%, Caucasian-22%According to Screenvision.com, 85% of Hispanics go to the movies Average household income in Alameda County - $75,284

Steps to Increase utilizationImprove search engine marketingPurchase Google ad words associated with cardiology and obstetricsCreate a user friendly websiteMake it a 1-2-3 step process to scheduling a patientHave a number to call for consultationCreate a general inquiry form Purchase movie screen advertisements for $18/screenPromote profitable service lines at health fairsBlood pressure screenings, planned parenting classes, etc.

Obstetrics ServicesSRH market share (28%)1 of 6 hospitals with a Percutaneous Coronary Intervention (PCI) contract in Alameda CountyKaiser-Hayward closing increased occupancy Current: 60% capacityTarget: 85% capacity

SRH market share (15%)85% of patient discharges are Medi-Cal Current: 44% capacityTarget: 85% capacity

Cardiac ServicesRevenue and Profit Increasing the Cardiology department capacity from 60 - 85% will bring in $700,000 of revenueIncreasing the Obstetrics department capacity from 44 - 85% will bring in $1.8 million of revenueMeasure A FundsAppeal to Alameda County Board of Supervisors for more Measure A Funds due toSt. Rose Hospital (SRH)Medi-Cal- 60% (largest amount in county)7.6%- indigent care2.5%- Measure A fundsAlameda County Medical Center (ACMC)76.5%- indigent care75%- Measure A Funds

ResultsProfitCardiology: $700,000Obstetrics: $1.8 millionRetentionPhysician loyaltyReimbursementMeasure A funds$5 million

Improving Community Outreach services Modify community benefit servicesProper access to primary care Transform Silva Pediatric Clinic

Modifications to Community Benefit ServicesAddress key health concerns:Hypertension and obesity Educate with health monitoring and preventive care measuresAsthmaUtilize Care - A - Van services for early detection of the health issues

Proper Access to primary CareEducate community on access to primary careED navigator Triage patients to urgent care and outpatient services

TransformationTransform Silva Pediatric Clinic

Retain the Silva Pediatric Clinic Transform it into an outpatient clinicManage overcrowding at the ED Currently, functioning at 103% of it capacity Potential stress due to Kaisers relocation Modify urgent care and outpatient clinic hoursUrgent care: 10:00 am to 12:00 am Clinic hours: 7:00 am to 7:00 pmSTRATEGY BENEFITSImprove operationsCollection processFinancial guidanceRenegotiating contractsPhysician integrationCardiology: $700,000Obstetrics: $1.8 millionMeasure A funds adjustment: $5 millionCommunity outreachImprove patient accessEfficient utilizationTACKLING THE DEBT